Croup

About croup

Croup is a childhood condition that affects the windpipe (trachea), the airways to the lungs (the bronchi) and the voice box (larynx).

Children with croup have a distinctive barking cough and will make a harsh sound, known as stridor, when they breathe in.

They may also have a hoarse voice and find it difficult to breathe because their airway is blocked.

Croup can usually be diagnosed by a GP and treated at home. However, if your child’s symptoms are severe and they are finding it difficult to breathe, take them to the nearest hospital’s accident and emergency (A&E) department.

Why does croup happen?

Who is affected by croup?

Croup usually affects young children aged between six months and three years, with most cases occurring in one-year-olds.

However, croup can sometimes develop in babies as young as three months, and older children up to 15 years of age. Adults can also get croup but this is rare.

The condition is more common during the late autumn and early winter months.

It tends to affect more boys than girls.

A child may experience croup more than once during childhood.

Treating croup

Most cases of croup are mild and can be treated at home. Sitting your child upright and comforting them if they are distressed is important, because crying may make symptoms worse. Your child should also drink plenty of fluids to prevent dehydration.

A single dose of an oral corticosteroid medication called dexamethasone or prednisolone will usually also be prescribed to help reduce the swelling in the throat.

If your child has breathing problems they may need hospital treatment, such as adrenaline and oxygen through a mask.

Some of these symptoms may indicate a potentially life-threatening underlying condition called epiglottitis (inflammation and swelling of the epiglottis).

The symptoms could also indicate tracheitis (inflammation of the windpipe), which also requires immediate medical attention.

Causes of croup

Croup usually develops as the result of a viral infection. The infection causes the larynx (voice box) to become swollen and the trachea (windpipe) to become blocked, and may affect the tubes in the lungs (bronchi). It is sometimes called laryngo-tracheo-bronchitis

Parainfluenza virus

The parainfluenza virus is the most common cause of croup. Four strains of the virus are responsible for most croup cases. These are:

parainfluenza I

parainfluenza II

parainfluenza III

parainfluenza IV

Parainfluenza I is responsible for most cases of croup.

The virus can be transmitted through close contact with infected people, as well as contaminated objects and surfaces. As with many airborne viruses, the parainfluenza virus is often spread by breathing in droplets from infected coughs or sneezes.

Other viruses

A number of other viruses can also cause croup. These include:

influenza A and B (flu viruses)

the measles virus, in children who have not been immunised against measles

the rhinovirus (common cold virus)

enteroviruses

the respiratory syncytial virus (RSV), which can cause severe breathing problems and pneumonia in babies

Other causes

Less common causes of croup include:

inhaling a small object such as a peanut or a pen cap (inhaled foreign body)

epiglottitis – inflammation of the epiglottis, (the flap at the base of the tongue that keeps food from going into the windpipe)

an allergic reaction to substances such as pollen or dust mites

inhalation of irritants, such as chemicals

acid leaking back out of the stomach and into the throat (acid reflux)

Diagnosing croup

A GP can diagnose croup by studying your child's symptoms, particularly the sound of their cough. They may also check your child's temperature for a fever and ask whether they have recently had a cold or viral infection.

In some cases, a pulse oximetry test may be carried out. This involves clipping a sensor onto your child's earlobe or finger to find out their oxygen levels.

The test does not hurt and should not distress your child, and determines whether your child is absorbing enough oxygen into their blood.

Your GP will decide whether your child needs to be admitted to hospital or whether their croup is safe to treat at home.

You should not try to check your child's throat yourself, because it could trigger a spasm (sudden narrowing) of the airway. This could cause the airway to swell even more, making breathing even more difficult.

Ruling out other conditions

Croup can usually be diagnosed by studying your child’s symptoms, but your GP may want to rule out other conditions that can cause similar symptoms.

Other possible causes for your child’s symptoms are:

an abnormality of the airway, which has been present from birth

an abscess in the tissues in the back of the throat

inhaled material (something they have breathed in)

swelling of the deeper layers of the skin (angio-oedema)

epiglottitis

congenital lesion

an allergic reaction

In very rare cases, epiglottitis (inflammation of the epiglottis) or tracheitis (inflammation of the windpipe) can cause similar symptoms to croup. In these cases, however, your child will usually feel very unwell generally, rather than just having the specific symptoms of croup.

Differentiating these causes from croup may require further tests.

Further investigation

If your child is admitted to hospital with severe croup, or if treatment is unsuccessful, further investigations may be needed to examine their neck and chest area for a possible obstruction.

An X-ray may be recommended if it is thought your child may have inhaled something and it is obstructing their airway.

Treating croup

Treatment of croup depends on how severe the symptoms are. Most cases are mild and can be managed at home.

However, if your child has severe croup, they will need to be admitted to hospital urgently.

Treatment croup at home

If your GP thinks your child has mild croup, they will usually recommend managing it at home.

This will often involve using children's paracetamol to ease any pain associated with the condition and may help lower your child's temperature if they have a fever.

You should also ensure your child is well hydrated by encouraging them to drink plenty of fluids.

Comforting your child is also important because their symptoms may get worse if they are agitated or crying. If your child is distressed, sitting them upright on your lap will help to comfort and reassure them.

Your GP will usually prescribe a single dose of an oral corticosteroid medication called dexamethasone or prednisolone to help reduce swelling (inflammation) in your child's throat. Side effects of these medications can include restlessness, vomiting, upset stomach and headache.

Steam treatment is not advised for the treatment of croup. There is no evidence that allowing your child to breathe in humid air, for example steam from a hot bath or shower in a closed room, will help.

Painkillers for children

Painkillers, such as paracetamol and ibuprofen, are available in liquid form for children. You can get liquid paracetamol and ibuprofen over the counter from pharmacies and some supermarkets.

Children under 16 years of age should not be given aspirin.

Speak to your pharmacist or GP if you are unsure about what type of painkiller is suitable for your child.

Do not use cough medicines or decongestants as these do not help ease the symptoms of croup. These treatments often have drowsy side effects, which can be dangerous when a child has breathing difficulties.

Hospital treatment

In severe cases of croup, treatment in hospital may be required.

Breathing problems, such as shortness of breath, are a major symptom of severe croup.

You should dial 999 immediately for an ambulance if your child is struggling to breathe.

If your child has severe croup, they may be given adrenaline through a nebuliser. This will help improve symptoms within 10 to 30 minutes and the effects should last for up to two hours. A nebuliser allows your child to breathe the medication as a mist.

If your child is very distressed and finding it difficult to breathe, they will be given oxygen through an oxygen mask.

As with milder cases of croup, oral dexamethasone or prednisolone will usually be given to help reduce any swelling in your child’s airways.

In rare cases croup may require hospitalisation, where a child may need intubation. During intubation, a tube is inserted either through a nostril or the mouth and passed down into the windpipe. This will help your child breathe more easily.

Intubation is usually performed under general anaesthetic. This means your child will be completely unconscious throughout the procedure so they do not experience pain or distress.